Provider Demographics
NPI:1689401523
Name:JOSH HEADLEY DMD LLC
Entity type:Organization
Organization Name:JOSH HEADLEY DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HEADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-504-8250
Mailing Address - Street 1:4755 LIBERTY PARK LN
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2255
Mailing Address - Country:US
Mailing Address - Phone:256-504-8250
Mailing Address - Fax:
Practice Address - Street 1:4643 CAMP COLEMAN RD STE 125
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2838
Practice Address - Country:US
Practice Address - Phone:205-774-1823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral Practice